Who I Treat Cognitive behavioral treatment (CBT) Speaking Engagements
Specializing in Cognitive Behavioral Therapy for Anxiety, Obsessive Compulsive Spectrum, and Related Conditions
 

Insurance

Dr. Jacobsen is considered an “out of network” provider. She does not participate in any health insurance or managed care company plans.

A statement will be provided at the end of each appointment that should include all information necessary to receive reimbursement from your insurance company. You may submit this statement to your insurance company and/or save it for your financial records. If planning to submit to insurance, it is recommended that you contact your insurance company in advance to verify that your benefits include out-of-network coverage and the details of this. You will then be reimbursed directly by your insurance company based on the terms of your policy.

Dr. Jacobsen is not a covered provider for either Medicare or Medicaid. In such circumstances, patients must forego the use of these benefits for her services and will not be eligible to independently file claims.

 
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 A Note On Out-Of-Network Services

While the fee for out of network services may initially be higher, benefits of out-of-network psychotherapy services include:

  • The ability to develop an individualized treatment plan with your therapist (e.g., length, intensity and type of therapy) based on clinical need and evidence-based practice as opposed to regulated protocols imposed by third party payers

  • The choice to not involve any third parties in billing or paperwork

  • An investment in evidence-based treatment that most often reduces or even eliminates the need for such services over time, often resulting in lower out-of-pocket costs in the long run

 
 

Fees

The cost of the initial evaluation is $350. This includes a 90-120 minute structured clinical interview, review of treatment history and relevant records, and initial contact with other providers, when applicable.

Following the evaluation, fees for treatment services are billed at $185 per 45 minute time block and prorated for lesser or greater professional time. All professional services, including office sessions, scheduled and unscheduled phone sessions, requested report writing or documentation, travel time (for home and community services), and professional consultation, are prorated and billed in the same manner.

Payments are collected at the time of service. Payments may be made by check, debit card, or credit card (MasterCard, Visa, Discover).

 
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Cancellation/No Show Policy

No-shows and cancellations without 24-hours notice (for regular appointments) are subject to the full session fee (up to 45-minutes). Repeated late cancellations or no shows may result in your treatment being terminated.

Good Faith Estimate for Health Care Items and Services

The Federal government has passed the No Surprises Act, which went into effect on January 1, 2022. This Act requires that all healthcare providers notify clients of their Federal rights and protections against “surprise billing.” This Act requires that we notify you of your federally protected rights to receive a notification when services are rendered by an out-of-network provider if a client is uninsured or elects not to use their insurance. Additionally, we are required to provide you with a Good Faith Estimate of the cost of services. It is difficult to determine the true length of treatment for psychological services, and each client has a right to decide how long they would like to participate in mental health care. Therefore, I will provide you with a Good Faith Estimate, and we will collaborate on a regular basis to determine how many sessions you may need.

This Good Faith Estimate shows the costs of services that are reasonably expected for your treatment. The estimate is based on information known at the time the estimate was created. The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill. If you are billed for more than this Good Faith Estimate, you have the right to dispute the bill. You may contact the health care provider or facility listed to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available. You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill. There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.

To learn more and get a form to start the process, go to www.cms.gov/nosurprises or call me at 913-575-0320. For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or (800) 368-1019. It is recommended to keep a copy of the Good Faith Estimate in a safe place or take a picture of it.